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How Can I Stop my Recent Acne Breakout? I Want To Prevent Scarring. (photo)

I had acne when I was 15 and it left some scaring on the side of my face, but never had I gotten acne on my cheeks. I went to sleep one night and the next morning acne was everywhere on my cheeks. I have eczema and very sensitive skin. I don't know what to do and am really scared of getting scars.

Doctor Answers (2)

Acne and acne scar treatments

+3

Acne is a disease of the hair follicle, caused by a combination of both internal and external factors.  Abnormal build-up of skin cells causes a plug at the opening of the hair follicle, creating a clogged pore, the first step in acne lesion formation.  The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.

Acne lesions can be non-inflamed whiteheads and blackheads (comedones), pustules, red papules, cysts or nodules.

The first step in acne lesion formation involves an abnormal build-up of skin cells at the opening of the hair follicle, creating a clogged pore (microcomedo).

The clogged pore accumulates keratin, oil (sebum) and bacteria until it ruptures, releasing this mixture into the skin and causing inflammation. This inflammation can lead to painful cyst/abscess formation and scarring.

Trying to squeeze out a pimple or cyst creates more even more inflammation. The lining of the hair follicle is thin. It is stretched and thinned further by the accumulation of oil, keratin and bacteria below the plugged opening. Squeezing the pimple partially releases the contents onto the surface of the skin, but also ruptures the lining of the hair follicle and lets this mixture spill out into the dermis, where the cells of the immune system mount an attack to remove it. This deep inflammation promotes scarring even more.

Sudden acne breakouts can potentially have a number of causes:

  • Hormones.  These can be internal, meaning your body is producing more androgens (male-like hormones responsible for acne).  These can be seen in conditions like polycystic ovary syndrome or pregnancy.  Hormones can also be affected by medications, such as certain oral contraceptives (birth control pills), IUDs with hormones (usually progesterone-based) and depo contraception injections.  Birth control medications are usually a combination of estrogens and progesterones or progesterones alone.  Certain progesterones can flare acne.
  • Medications.  Corticosteroids, such as prednisone, which are commonly used for inflammatory conditions, are well known for flaring acne.  Using cortisone creams or lotions on the face can also flare acne.  Other medications that flare acne include: chemotherapy medications like epidermal growth factor receptor inhibitors, dactinomycin (another chemotherapy drug), immunosuppressive mediactions, such as sirolimus, cyclosporine and tumor necrosis factor inhibitors (these are used for psoriasis, rheumatoid arthritis, Crohn's disease, and other conditions) , certain anti-depressant and other psychoactive medications, anticonvulsants, like valproic acid and phenytoin, Other medications include antituberculosis drugs, antibiotics such as rifampin,
  • Anabolic steroids.  Those are used medically but certain ones can be used illegally to enhance sports or athletic performance.
  • Stress
  • Diet.  A diet that contains large quantities of dairy products such as milk, cheese, yogurt, ice cream, sports nutrition bars and drinks, even milk chocolate tends to cause acne breakouts.  High glycemic index/load foods, such as simple carbohydrates are also associated with acne breakouts.
  • Sun exposure and hot, humid weather.  Although sun exposure initially tends to make acne better, it eventually stimulates more oil (sebum) production leading to more acne eruptions.
  • Topical products such as heavy creams, oils or moisturizers that are applied to facial skin can block pores and cause acne.
  • Halogens, such as those in certain thyroid medications, some vitamins and minerals and others

If the acne breakout is sudden and severe, I recommend a consultation with a board-certified dermatologist to determine the cause and start treatment.  If your acne resulted in some scars previously, there is a potential for scarring again. 

My treatment approach to acne includes:

Diet and hormones

  • There are multiple androgenic, anabolic and growth hormones present in cow's milk. Consumption of milk and dairy products leads to worsening of acne, as there is no such thing as hormone-free cow's milk. Discontinuing consumption of milk and dairy products, such as cheese, yogurt, butter, ice cream, sour cream and even milk chocolate, and eating a diet of lean proteins, unsaturated fats and complex carbohydrates will be helpful in acne control.
  • For women taking birth control pills, many of those preparations have androgenic (male hormone-like) properties and can contribute to significant acne eruptions. Progestins in these medications, depot injections and intrauterine devices are the most likely to cause acne.

Acne surgery

  • Superficial chemical peels or cortisone injections are sufficient treatments for many patients if they have just a few lesions.

Medications

  • Most of these medications are prescribed by a dermatologist after a thorough evaluation of the skin, medical history, hormonal status, allergies and other factors that go into the decision about acne treatment choices. There are some over-the-counter options that can be tried first, like benzoyl peroxide washes or gels.

Acne sometimes flares during pregnancy. There are very limited choices for acne treatment in pregnant women. Most acne medications are contraindicated in pregnancy or we just don't have information on how they could affect the baby. If you are pregnant and seeking acne treatment, please consult with a dermatologist first, before starting any acne treatment regimen.

For mild to moderate acne:

  • Benzoyl peroxide
  • Topical retinoids, like Retin A, Differin, Tazorac
  • Topical antibiotics, like clindamycin, erythromycin, sulfur/sulfacetamide combinations.

For nodular, cystic or scarring acne:

  • Systemic antibiotics
  • Antiandrogens, like spironolactone.
  • Isotretinoin may be needed for more severe or resistant cases.

Laser and Light Treatments

  • Intense Pulsed Light (IPL)
  • MicroLaserPeel
  • Fractional Laser treatments.

These therapies can be used alone or in combination with acne medications in order to achieve the best results in acne treatment.


Short Hills Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Acne Control With Laser

+1

Make sure you always go to bed after clearing all makeup and dirt from your skin. However, acne is not always caused by these factors alone. For most people, it results from hormonal fluctuations as well as genetics.

It is now possible to control acne breakouts with the Spectra laser. Although it is relatively new, it is still something to consider because the results are more predictable and consistent. It also offers a higher level of safety compared to topical and oral medications.

The laser stimulates the turnover of new skin cells because it works on deeper layers of the skin. It also reduces the activity level of sebaceous glands which secrete oil that contributes to acne.

Acne scars are the result of inflammation. And the inflammation is due to bacteria, which is effectively addressed by this laser.

Blocked pores are cleared due to the interaction of the laser with a special topical cream. 

After the procedure, you will notice that the size of your acne will be noticeably a lot smaller. After 3-4 treatments the number of pimples will have decreased.

 

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
5.0 out of 5 stars 22 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.